36C26120Q0235.docx

36C26120Q0235

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1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C26120Q0235 09-03-2020 Joleo B. Dianala, joleo.dianala@va.gov 916-923-4575 09-17-2020 15:00

612MCP

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) VA Northern California HealthCare System 5342 Dudley Blvd, Bldg 209 McClellan

CA

95652-2609 X 621498 $22 Million N/A X Reference PWS

612MCP

Department of Veterans Affairs Department of Veterans Affairs VA Northern California HealthCare System 3230 Peacekeeper Way, Bldg. 209 McClellan

CA

95652-1012

FMS VA-9(101) Financial Services Center PO Box 149971 Austin

TX

78714-9971 Contractor shall provide Primary Care Support Services to eligible Veterans for the VA Pacific Island Healthcare System on the island of Molokai, Hawaii.

*See 52.212-1 and 852.273-73 for submission instructions.* All questions are due not later than 09/17/2020 at

3:00 PM PST.

X X

JOLEO B. DIANALA

VA-VHA-2020-378F6FAE

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C261

Network Contracting Office 21 VA Northern California HealthCare System 5342 Dudley Blvd, Bldg 209 McClellan, CA 95652-2609

Use NCO21MedicalSharingTeam@va.gov as an alternate contact information should your POC be non-responsive or no longer assigned to NCO 21. Include in subject line, the Contract Number and ATTN: “Individual name attempted to contact”

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Department of Veterans Affairs Financial Services Center P.O. Box 149971, Austin TX 78714-9971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

Secure Fax - Please review VA Handbook 6500 that requires the following statement on all fax cover sheets be included: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

Post Award Orientation The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by Procurement Policy Memorandum (PPM) 2019- 01. https://www.va.gov/oal/docs/business/pps/ppm201901.pdf

36C26120Q0235

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B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1. SERVICES REQUIRED: The VA Pacific Islands Healthcare System (VAPIHCS) requires the following services to be provided in a private office or clinic environment to Veterans, primarily residing in Molokai, HI: Site of care is (5V21 459QB).

[X] Other Outpatient Clinical Services Site of Care (Less than 500 encounters registered in primary care and mental health stop class within any given fiscal year or does not include MH Services) Clinical services are provided to remote areas through a Telehealth clinic or other arrangement. If any other services are provided in this venue (external to a VA clinic or facility), they must be associated with, attached to, and coordinated by a health care delivery site located in a clinic or facility.

1.2. PLACE OF PERFORMANCE: on the island of Molokai, HI

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of VAPIHCS, 459 Patterson Road Honolulu, HI 96819.

1.4. POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index and clinical guidelines. Performance and quality standards may change during the contract. New or revised quality/performance criteria or standards will be provided to the Contractor before implementation date and throughout the life of the contract through unilateral or bi-lateral modifications, as applicable. Copies of current VA and VHA publications can be located at http://www.va.gov/vhapublications/ or at http://www.va.gov/vapubs/. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, access, patient safety and performance, including, but not limited to the policies listed on the Contracted Clinic Policy Document located at https://www.patientcare.va.gov/primarycare/Resources.asp.

1.5. DEFINITIONS/ACRONYMS:

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACPE: American Council on Pharmaceutical Education

1.5.5. ACO: Administrative Contracting Officer

1.5.6. ADE: adverse drug events

1.5.7. AED: Automatic External Defibrillator

1.5.8. AIS: Automated Information Security

1.5.9. ANA: American Nurses Association

1.5.10. AOA: American Osteopathic Association

1.5.11. ARRT: American Registry of Radiologic Technology

1.5.12. ASC: Ambulatory Surgery Clinic

1.5.13. Assigned: A Veteran is “assigned” to an outpatient clinic via PCMM (i.e. CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

1.5.14. BAA: Business Associate Agreement

1.5.15. BI-RADS: Breast Imaging-Reporting and Data System; a quality assurance tool designed to standardize mammography reporting

1.5.16. BLS: Basic Life Support

1.5.17. BOS: Bureau of Osteopathic Specialists

1.5.18. CAHEA: Committee on Allied Health Education and Accreditation

1.5.19. CAP: College of American Pathologists

1.5.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21. CBO: VA Central Billing Office.

1.5.22. CDC: Centers for Disease Control and Prevention

1.5.23. CEU: Certified Education Unit

1.5.24. CLIA: Clinical Laboratory Improvement Amendments

1.5.25. CME: Continuing Medical Education

1.5.26. CMS: Center for Medicare and Medicaid Services

1.5.27. CO: Contracting Officer

1.5.28. COPD: chronic obstructive pulmonary disease

1.5.29. COR: Contracting Officer’s Representative

1.5.30. COS: Chief of Staff

1.5.31. CPA: Collaborative Practice Agreement

1.5.32. CPS: Clinical Pharmacy Specialist

1.5.33. CPT: Current Procedural Terminology

1.5.34. CRNP: Certified Registered Nurse Practitioners

1.5.35. CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org/ .

1.5.36. CPARS: Contractor Performance Assessment Reporting System

1.5.37. CVT: Clinical Video Telehealth

1.5.38. DICOM: Digital Image and Communication in Medicine

1.5.39. DIGMA: Drop in Group Medical Appointment

1.5.40. DRG: Diagnostic Related Group

1.5.41. DSS: Decision Support System

1.5.42. ECC Extended Care Center

1.5.43. Enrollment: The process of establishing eligibility for VA’s “Medical Benefits Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC/outpatient site of care, however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

1.5.44. EPRP: External Peer Review Program

1.5.45. FDA: Food and Drug Administration

1.5.46. FSMB: Federation of State Medical Boards

1.5.47. HCC: Health Care Center A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

1.5.48. HHS: Department of Health and Human Services

1.5.49. HCFA: HealthCare Financing Administration

1.5.50. HICPAC: Healthcare Infection Control Practices Advisory Committee- a federal advisory committee made up of 14 external infection control experts who provide advice and guidance to the CDC and the Secretary of HHS regarding the practice of health care infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

1.5.51. HT: Home Telehealth

1.5.52. ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.5.53. ICD 10: International Classification of Diseases 10th edition

1.5.54. iMED: Software used by VA for informed consent

1.5.55. INR: International Normalized Ratio

1.5.56. ISO: Information Security Officer

1.5.57. LIP: licensed independent practitioner

1.5.58. MCCR: Medical Care Cost Recovery

1.5.59. Mental Health Services: per VHA Handbook 1160.01 is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of both substance use disorders and other mental disorders.

General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems;

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence-based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education when it is associated with benefits to the Veterans;

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST).

Specialty mental health services include:

(a) Consultation and treatment services for the full range of mental health conditions;

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

(d) Psychosocial Rehabilitation Services, including: PRRCs, family psycho-education, family education, skills training, peer support, and Compensated Work Therapy (CWT) and supported employment;

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.5.60. MQSA: Mammography Quality Standards Act

1.5.61. MSN: Master of Science in Nursing

1.5.62. NCCPA: National Commission on Certification of Physician Assistants

1.5.63. NLN: National League for Nursing

1.5.64. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing Improvement in Cardiac Surgical Program

1.5.65. OTC: Over the Counter

1.5.66. PA: Physician Assistant

1.5.67. PACS: Picture Archiving and Communications System

1.5.68. PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

1.5.69. Parent Facility: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.5.70. PCMH: Patient-Centered Medical Home

1.5.71. PCMM: Primary Care Management Module- a software program used to track Primary Care Clinic Veteran rosters.

1.5.72. PCP: Primary Care Provider

1.5.73. Phar.D.: Doctor of Pharmacy

1.5.74. POC: Point of Care Testing

1.5.75. PRIMARY CARE VISIT: an episode of care furnished in a clinic that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care includes, but is not limited to, diagnosis and management of acute and chronic biopsychosocial conditions, health promotion, disease prevention, overall care management, and patient and caregiver education. The VHA site classification defines primary care as those encounters that occur within the primary care class of encounters.

1.5.76. PCMHI: Primary Care-Mental Health Integration

1.5.77. PWS: Performance Work Statement

1.5.78. QAPI: Quality Assessment and Performance Improvement

1.5.79. QASP: Quality Assurance Surveillance Plan

1.5.80. RME: reusable medical equipment

1.5.81. SOP (Clinical): Scope of Practice

1.5.82. SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care. Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.83. SFT: Store and Forward Telehealth

1.5.84. SMA: Shared Medical Appointments

1.5.85. SPD: Sterile Processing Division

1.5.86. SPE: Senior Procurement Executive

1.5.87. SPECIALTY CARE VISIT: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care, and is only provided through a referral.” These services are generally divided into two sub-categories: medicine specialties and surgery specialties. The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy; cardiology; dermatology; emergency; employee health; endocrinology; gastroenterology; general medicine; hematology or oncology; infectious disease; nephrology; neurology; outreach; pulmonary or respiratory disease; rheumatology; amputation follow-up; amputation; anesthesia; cardio-thoracic; ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN); neurosurgery; orthopedics; plastic surgery; urology; or vascular clinic stops.

1.5.88. SUPPORT STAFF: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of RNs, LPNs, Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.5.89. TJC: The Joint Commission

1.5.90. TIU: Text Integration Utility

1.5.91. TCT: Telehealth Clinical Technicians

1.5.92. VA: Veterans Affairs

1.5.93. VA EHR: VA electronic health record

1.5.94. VAMC: Veterans Affairs Medical Center

1.5.95. VetPro: a federal web-based credentialing program for healthcare providers.

1.5.96. VHA: Veterans Health Administration

1.5.97. VVC: VA Video Connect

1.5.98. WHEN: Weeknd-Holiday-Every Night

2. STAFFING AND QUALIFICATIONS

2.1. MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS:

PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI)staff). The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The VA shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management Module (PCMM) for Primary Care. The staffing standard for support staff shall be in ratios to Primary Care Providers of at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). Total Estimated Patients enrolled/assigned to site: 190.

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party: Shall be provided by the VAPIHCS. The Contractor does not need to fulfill this requirement.

2.3. PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing, with the exception of telehealth clinical technician, shall be provided by the VAPIHCS.

2.3.1. TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. The VAPIHCS will provide the teamlet member 1. Teamlet member 1 will be a physician provided by VAPIHCS. The physician is a .95 FTE for the VAPIHCS but will only be on-site providing services at the clinic for 30 hours (.75 FTE) per week. The PCP will be off-site on VA National work travel the remaining time. When the physician is sick, all appointments are cancelled for the day and immediately rescheduled. If services are imminent, veterans will be referred to a community care provider. When a physician is on leave, another provider from VAPIHCS Oahu will fly to Molokai island to cover the clinic days

OPTION 1: Physician (MD) (provided by VAPIHCS): The physician will be provided by the VAPIHCS. The contractor does not need to fulfill this requirement.

2.3.2. TEAMLET MEMBER 2 (provided by VAPIHCS): Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: 1 FTE. Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2. The Teamlet member 2 will be provided by the VAPIHCS. When the RN is sick on a non-clinic day, all appointments are cancelled and rescheduled. A non-clinic day is defined as a day in which the PCP is not on-site and where veterans have appointments with the RN. When the RN is sick on a clinic day, the Teamlet Member 1 will complete the initial check-in and vitals for the patients.RIMARY CARE STAFFING – CLINICAL ASSOCIATE [X] Mandatory for all sites

2.3.3. TEAMLET MEMBER 3: CLINICAL ASSOCIATE (to be provided by VAPIHCS) FTE Ratio Performance Standard: 1 FTE to be provided by the VAPIHCS.

OPTION 1: Licensed Practical Nurse (LPN): 1 FTE to be provided by VAPIHCS.

PRIMARY CARE STAFFING – CLERICAL ASSOCIATE [X] Mandatory for all sites

2.3.4. TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio Performance Standard: 1 FTE (to be provided by Contractor). Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations .Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT.

2.4. DISCIPLINE SPECIFIC PACT TEAM MEMBERS (REQUIRED FOR ALL SITES): Discipline-specific team members are designated in PCMM for one or more PACT(s). Discipline-specific team members provide continuity of direct discipline-specific care to all patients assigned to PACT(s) for which the team member is designated. Discipline specific staffing will not be provided by the Contractor.

2.4.1. DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS) – PACT: FTE Ratio Performance Standard: 1.0 FTE per 3 PACTs Qualifications: Will be provided by the VAPIHCS via telehealth. STA

2.4.2. DISCIPLINE SPECIFIC 2: CLINICAL PHARMACY SPECIALIST (CPS) ANTI-COAGULATION: FTE Ratio Performance Standard: 1.0 FTE per 5 PACTs. Qualifications: Will be provided by the VAPIHCS via telehealth. STAEXPANDED PACT STAFD PACT STAF

2.4.3. DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER (this position provides general/medical social work services): FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Qualifications: Will be provided by the VAPIHCS via telehealth and on-site. The social worker typically flies into Molokai for appointments on an as needed basis which has historically been one to two times per month.

2.4.4. DISCIPLINE SPECIFIC 4: REGISTERED DIETITIAN/NUTRITIONIST: FTE Ratio Performance Standard: 1 FTE per 5 PACTs. Qualifications: Will be provided by the VAPIHCS via telehealth.

2.4.5. DISCIPLINE SPECIFIC 5: PRIMARY CARE MENTAL HEALTH INTEGRATION (PC-MHI):

FTE Ratio Performance Standard - 0.05 FTE to be provided by the VAPIHCS through a psychologist. The psychologist flies to Molokai for clinic days at least once a month and is on-site for one business day.

2.5. SPECIALTY CARE STAFFING: Specialty care services are not offered at this outpatient site of care. For speciality care services not provided for at the outpatient site of care, the VAPIHCS will refer patients either for local services from private providers (reimbursed through TriWest) or refer patients to Oahu, HI, where the clinic can provide a wide range of services. Referral to the island of Oahu, HI requires the veteran to travel by plane.

2.6 ANCILLARY SUPPORT SERVICES STAFFING: Ancillary support services are not provided for at this outpatient site of care. Radiology and/or phlebotomy services will be provided by local community providers or by referral for a trip to the VA Clinic on Oahu, HI.

2.7 GENERAL AND SPECIALTY MENTAL HEALTH STAFFING: General and mental health staffing will be provided by the VAPIHCS via telehealth and on-site. A VAPIHCS psychologist flies to the island of Molokai at least once a month (1 day trip) to provide services. Any other services that are not provided on site is accomplished through telehealth appointments.

2.7.1 Suicide Prevention Coordinator (SPC): The VA performance standard for sites with 10,000 patients or more is maintaining a Suicide Prevention Coordinator (SPC) with a full-time commitment to suicide prevention activities. In smaller sites serving less than 10,000, this may be a collateral assignment. Will be provided by the VAPIHCS.

2.7.2 Homeless Outreach Specialist: To ensure the availability of outreach and referral services to homeless Veterans, all sites with 10,000 patients or more must designate at least one outreach specialist, usually a clinical social worker, to provide services to homeless Veterans. NOTE: In smaller facilities, this may be a collateral assignment. Will be provided by the VAPIHCS.

2.8 TELEHEALTH SERVICES CLINICAL STAFF: Telehealth Clinical Technician (TCT) FTE Ratio performance standard 1.0 FTE Telehealth Clinical Technician (TCT) per estimated 5,000 patients at clinic, with a trained back-up (e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic telehealth services). All staff providing telehealth related services (primary TCT(s) and back-ups) must be trained in teleretinal imaging, teledermatology, teleaudiology, tele-mental health, teleprimary care etc. The qualifications, competencies, and position responsibilities noted below apply to primary TCT(s) and back-ups. The Telepresenter can be any clinically trained person assisting the provider in the presentation of the Veteran using video-conferencing. Depending on the skills needed for the encounter, the Telepresenter can be a licensed independent provider (LIP), Registered Nurse, LPN, or Telehealth Clinical Technician (TCT). Telepresenters can also serve as TCT back-ups. The number and discipline of Contractor’s staff trained to function as a TCT back-up or Telepresenter will be based on the volume and type of telehealth services provided. The VAPIHCS RN (PACT Teamlet Member #2) will provide TCT and telepresenter services. The Administrative Associate (Teamlet Member #4) will undergo training to be a TCT and shall have the qualifications listed below to be a TCT. The TCT will only help wth the set up and monitoring, facilitating of the telehealth appointments.

2.8.1 Qualifications: All staff providing telehealth related services into the clinic shall be appropriately credentialed and; where necessary, privileged. All contractor staff who support and manage telehealth services must be working within permitted licensure and scope of practice. Where non-licensed staff is supporting telehealth services the Contractor’s licensed staff must provide appropriate clinical supervision.

2.8.2 Competency – TCTs, Telepresenters, Store and Forward Imagers et al. and their back-ups, shall be expected to provide clinical care in compliance with established clinical protocol. Additional guidelines governing operations will be utilized and provided to Contractor by VA. TCTs, Telepresenters, Store and Forward Imagers and back-ups shall be expected to successfully complete training programs required for certification as a TCT, Telepresenter and/ or Store and Forward Imager and back-up including VA required training and any VA training mandated for TCT, Telepresenter, Teleretinal Imagers. TCTs, Telepresenters, and Store and Forward Imagers shall be responsible for maintaining imager and/or other required certification. TCTs, Telepresenters, and Store and Forward Imagers and back-ups shall be expected to demonstrate competency on the function and use of the telehealth equipment including digital retinal and dermatology imaging system, teleaudiology hardware and software. VA will provide training to TCTs, Telepresenters, Store and Forward Imagers and back-ups and document competency.

2.8.3 TCT Position Responsibilities: TCT manages the Telehealth Services offered by the clinic (i.e., presenting, equipment management, training, imaging, audiology services, etc.) and is responsible for the provision of covered services to enrolled and unassigned patients presenting for care. The Contractor’s telehealth services shall include but are not limited to: coordinating telehealth clinic set up, scheduling, equipment management, provision of data on request, attendance on VA or Network Telehealth Team calls, maintaining records required for quality control processes, and participating in performance improvement activities. The TCT shall be responsible for conveyance of clinically appropriate in-person interaction or on-site observations (e.g., assisting with hearing aid fittings, detection of alcohol use, etc.) with the Veteran patient to the telehealth provider. The TCT shall communicate regularly with the Facility Telehealth Coordinator (FTC) to work out any process issues, equipment needs/problems, data collection and any other logistical issues.

2.8.4 Telepresenter Position Responsibilities: Include, but are not limited to the following: Assist the primary care or specialty care provider with the Veteran physical exam as needed, provide Veteran education, documentation and assistance with workload capture for the completion of the visit, per scope of practice and manage required screenings and complete clinical reminders, documentation, scheduling and opening and closing the encounter. The Telepresenter shall be responsible for gathering and transmitting telehealth images, sounds, data and all other supporting data to the assigned VA providers or reading centers within time lines established by policy. The Telepresenter shall provide technology education to patients including but not limited to: review of acquired data or images for anatomic and general findings, review of photos, and provision of VA approved handouts.

2.9 LICENSE AND ACCREDITATION: The Contractor is not required to provide any physician(s) or licensed providers. The qualifications below pertain only to the Teamlet Member #4, if applicable.

2.9.1 Technical Proficiency/Board Certification: Personnel shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently.

2.9.2 The Contractor must ensure that all individuals who provide services and/or supervise services at the Contractor’s Outpatient Site of Care, including individuals furnishing services under contract are qualified to provide or supervise such services.

2.9.3 Position specific competencies shall be completed for all staff annually.

2.9.4 Contractor staff qualifications, licenses, certifications and facility Joint Commission or equivalent accreditation must be maintained throughout the contract period of performance. If Contractor’s staff is not directly employed by the treating facility, documentation must be provided to the COR to ensure adequate certification. All actions required for maintaining certification must be kept up to date always. Documentation verifying current licenses, certifications and facility accreditation must be provided by the Contractor on an annual basis.

2.9.5 The Contractor is responsible for assuring that all persons, whether they be employees, agents, subcontractors, providers or anyone acting for or on behalf of the Contractor, are properly licensed always under the applicable state law and/or regulations of the provider’s license, and shall be subject to credentialing and privileging requirements by VA.

2.9.6 The Contractor shall not permit any employee to begin work at an Outpatient Site of Care prior to confirmation from the VA that the individual’s background investigation has been reviewed and released to the Office of Personnel Management (OPM), by the Security and Investigations Center (SIC).

2.10 CREDENTIALING AND PRIVILEGING: This section is N/A. The Contractor is not required to provide any physician(s) or licensed providers.

2.11 TRAINING (ACLS/BLS/VA MANDATORY): This section is N/A. The Contractor is not required to provide any physician(s) or licensed providers. The RN provided by the VAPIHCS is trained in BLS and the physician provided by the VAPIHCS is trained in ACLS.

2.12 ACCESS TO PATIENT INFORMATION: In performance of official duties, Contractor’s provider(s) have regular access to printed and electronic files containing sensitive data, which must be protected under the provisions of the Privacy Act of 1974 (5 U.S.C. 552a), and other applicable laws, Federal Regulations, Veterans Affairs statutes and policies. Contractor’s provider(s) are responsible for (1) protecting that data from unauthorized release or from loss, alteration, or unauthorized deletion and (2) following all applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in a computer access agreement which contract provider(s) signs.

2.12.1 Contractor staff shall complete required security training and sign a VA Computer Access Agreement prior to having access to the VA computer system. Security Training will be accomplished annually. Contractor staff shall select training modules for Privacy Training and Information Security Training. Upon completion of the training, please email or fax training certificates to the Contracting Officer at joleo.dianala@va.gov.

2.12.2 In addition, if providing clinical services, Contractor staff will attend VA EHR training prior to providing any patient care services. Contractor staff shall document patient care in the VA EHR to comply with all VA and equivalent TJC standards.

2.12.3 All contract personnel requiring access to PHI / Encrypted information must obtain a PIV card to ensure secure communications to and from the VA (e.g. Clinical staff, contract billing staff requiring patient lists with PHI/PII and Contract management personnel requiring PHI/PII information).

2.13 RULES OF BEHAVIOR FOR AUTOMATED INFORMATION SYSTEMS: Contractor staff having access to VA Information Systems are required to read and sign a Rules of Behavior statement which outlines rules of behavior related to VA Automated Information Systems. The COR will provide, through the facility ISO, the Rules of Behavior to The Contractor for the respective facility. A copy of the Rules of Behavior may also be found in the attachments section of this solicitation (Section D).

2.14 STANDARD INFECTION CONTROL MEASURES (PPD, IMMUNIZATIONS, ETC.): Contractor shall provide statement that all required infection control testing and immunizations for their personnel are current and that the contractor is compliant with OSHA regulations concerning occupational exposure to blood borne pathogens. All clinic staff are required to receive annual influenza vaccination. Staff unable or unwilling to be vaccinated are required to wear a face mask throughout the influenza season. The Contractor shall also notify the VA of any significant communicable disease exposures and the VA will also notify the contractor of the same, as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in Health Care Personnel (as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for infection control in their personnel. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.15 NATIONAL PROVIDER IDENTIFICATION (NPI): N/A as there are no provided physicians or clinical staff provided by the contractor.

2.16 PRESCRIPTION DRUG MONITORING PROGRAM: VAPIHCS providers will be registered with the state prescription drug monitoring program in accordance with VHA Directive 1306, Querying State Prescription Drug Monitoring Programs (PDMP).

2.17 CONFLICT OF INTEREST: The Contractor is responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or sub-Contractors who shall provide services. The Contractor must also provide relevant facts that show how its organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest in accordance with VA Directive1660.03. See attachment in Section D.

2.18 CITIZENSHIP RELATED REQUIREMENTS:

2.18.1 The Contractor certifies that the Contractor shall comply with all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs.

2.18.2 While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, because of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.18.3 If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to Veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.18.4 This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.18.5 The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document.

2.19 ANNUAL OFFICE OF INSPECTOR GENERAL (OIG) STATEMENT: In accordance with The Health Insurance Portability and Accountability Act (HIPAA) and the Balanced Budget Act (BBA) of 1977, the VA OIG has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.19.1 Therefore, all Contractors shall review the OIG List of Excluded Individuals/Entities on the OIG web site at www.hhs.gov/oig to ensure that the proposed Contract staff and/or firm(s) are not listed. Contractors should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person or entity was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contract staff and entities that employ or enter contracts with excluded individuals or entities to provide items or services to Federal program beneficiaries.

2.19.2 By submitting their proposal, the Contractor certifies that the OIG List of Excluded Individuals/Entities has been reviewed and that the Contractor and/or firm is/are not listed as of the date the offer/bid was signed.

2.20 NON-PERSONAL SERVICES: The parties agree that The Contractor, contract staff, agents and sub-Contractors shall not be considered VA employees for any purpose. All individuals that provide services under this resultant contract and are not employees of the Contractor shall be regarded as subcontractors. The Contractor shall be responsible and accountable for the quality of care delivered by all its subcontractors. The Contractor shall be responsible for strict compliance of all contract terms and conditions without regard to who provides the service.

2.21 CONTRACT PERSONNEL: The Contractor shall be responsible for protecting all Contractor personnel furnishing services. To carry out this responsibility, The Contractor shall provide or certify that the following is provided for all contract staff providing services under the resultant contract:

Workers’ compensation Professional liability insurance Health examinations Income tax withholding, and Social security payments

2.22 INHERENTLY GOVERNMENTAL FUNCTIONS PROHIBITED. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees, selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.23 TORT: The Federal Tort Claims Act does not cover Contract staff. When a contract staff member has been identified as a provider in a tort claim, The Contractor’s staff member shall notify the Contractor’s legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s provider’s action or non-action is the responsibility of The Contractor and/or insurance carrier.

2.24 RYAN HAIGHT ACT: In support of providing Veterans access to comprehensive Telehealth services, including the provision of controlled substances in compliance with the Ryan Haight Act, Contractor shall apply for DEA registration if this option is available under state law. If DEA registration is not available under state law or the contractor is unable to obtain DEA registration, Contractor shall ensure a DEA registered provider can be present in the room with the patient during discussions of controlled substances prescriptions, at telehealth visits in which controlled substances are prescribed, if the patient has not had at least one prior in-person medical assessment with the prescribing provider.

3 HOURS OF OPERATION: The following outlines the required hours of operation:

3.1 BUSINESS HOURS: Monday through Friday, 8am-4:30pm. (RNCM, clinical associate, and administrative associate are present during these hours but Primary Care Provider only 3 days a week 0.75 FTE.). The Primary Care Provider is a .95 Government FTE but will only have open office hours for veterans .75 FTE.

3.2 EVENING HOURS: None

3.3 WEEKEND HOURS: None

3.4 FEDERAL HOLIDAYS: The following holidays are observed by the Department of Veterans Affairs: New Year’s Day, Washington’s Birthday, Martin Luther King’s Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving, Christmas,Any day specifically declared to be a national holiday. Services are not provided on any federal holidays.

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